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Medicare Proposes Easing MACRA Rules

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June 22, 2017

The Centers for Medicare & Medicaid Services (CMS) is proposing to exempt many smaller physician practices from MACRA—the recent law for updating physician payment rates—and make it easier for physicians to comply with the law’s quality performance and reporting requirements. The Medicare Access and CHIP Reauthorization Act, or MACRA, bases annual physician rate updates on how well physicians perform in meeting quality and cost metrics.


CMS proposed the following changes in the law’s two new payment tracks: 


Merit-Based Incentive Payment System (MIPS):  

  • Increase the “low-volume” threshold so more small practices and eligible clinicians in rural areas are exempt from MIPs requirements
  • Award extra performance points for practices that care for complex patients
  • Allow small practices to adopt certified electronic health record technology at a slower pace 
  • Provide additional performance points to physicians who consult appropriate use criteria when they use advanced diagnostic imaging
  • Delay using cost-savings as a factor in calculating physician performance


Advanced Alternative Payment Models (AAPM): 

  • Extend for two more years—rather than increase—the current level of financial risk that alternative payment models and their participating physicians must assume
  • Slow down the increase in the amount of total financial risk that medical homes must assume


CMS will accept comments on the proposals through August, 21, 2017. Once finalized, the policies will go into effect in Calendar Year 2018, but will not begin to affect actual payment updates until two years later.


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